Acute viral bronchiolitis in children- a very common condition with few therapeutic options

Abstract

Acute viral bronchiolitis remains a cause of substantial morbidity and health care costs in young infants. It is the most common lower respiratory tract condition and most common reason for admission to hospital in infants. Many respiratory viruses have been associated with acute viral bronchiolitis although respiratory syncytial virus (RSV) remains the most frequently identified virus. Most infants have a mild self limiting illness while others have more severe illness and require hospital admission and some will need ventilatory support. Differences in innate immune function in response to the respiratory viral insult as well as differences in the geometry of the airways may explain some of the variability in clinical pattern. Young age and history of prematurity remain the most important risk factors although male gender, indigenous status, exposure to tobacco smoke, poor socioeconomic factors and associated co-morbidities such as chronic lung disease and congenital heart disease increase the risks of more severe illness. Supportive therapy remains the major treatment option as no specific treatments to date have been shown to provide clinically important benefits except for inhaled hypertonic saline. Prophylaxis of high risk infants with palivizumab should be considered although the cost effectiveness is still unclear. Many questions remain regarding optimal management approaches for infants requiring hospitalisation with bronchiolitis including use of nasogastric feeding, the optimal role of supplemental oxygen, optimal use of hypertonic saline and the role of combinations of therapies, the use of heliox or modern physiotherapy approaches.

Respiratory morbidity of preterm infants of less than 33 weeks gestation without bronchopulmonary dysplasia: a 12-month follow-up of the CASTOR study cohort

“…Bronchiolitis is the most common seasonal viral lower respiratory tract infection (LRTI) in infancy [1][2][3].…”

“…Although <2% of infants with bronchiolitis require hospital admission, RSV is responsible for up to 75% of the hospitalizations for severe bronchiolitis in infants aged <1 year [2,4,6].…”

Association of Respiratory Viral Infection and Atopy with Severity of Acute Bronchiolitis in Infants

“…3,5,8) 대부분의 환아는 경한 임상 경과를 보이지 만, 3) 1-에서는 입원치료를 요하며 3% [4][5][6] 이 중 는 심한 15% 경과를 거쳐 장기입원 및 인공호흡기 치료를 요하는 경우도 있다. 6) 뿐만 아니라 중증 세기관지염의 경우 반복성 천명이 생길 가능성이 있으며, [1][2][3][4] 소아 천식이 발병할 가능성이 12 배 높다는 보고도 있다. [9][10][11][12] 이처럼 세기관지염의 중증도가 예후에 상당한 영향을 미칠 수 있다 중증 세기관지염의 위 .…”

“…[2][3][4][5][6] 최근 감염된 바이러스 종류 및 바이러스 아형에 따라 중 증도가 다르게 나타나고 2,3) 특히 중복 감염이 중증도에 상당 한 영향을 미친다는 보고가 있으며, 4,5) 아토피 가족력이나 [13][14][15][16] 환아의 아토피 소견 15) 및 간접 흡연이 [17][18][19] 중증 세기관 지염과 관련이 있다는 보고도 있다 그러나 일부에서는 세기 .…”

“…관지염의 중증도가 바이러스 [2][3][4][5] 및 아토피 소견과는 무관하 거나 방어적 효과를 나타내며 [18][19][20] 이미 존재하는 폐기능 감 소 15,21) 및 유전적 요인과 관련이 있다고 제시한다. Values are presented as no.…”